Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
CA 02582045 2007-03-30
DESCRIPTION
MEDICINAL COMPOSITION FOR PREVENTION OF TRANSITION TO
OPERATIVE TREATMENT FOR PROSTATIC HYPERTROPHY
Technical Field
[0001]
The present invention relates to a pharmaceutical
composition for the prevention of transition to surgical
therapy for benign prostatic hyperplasia.
[0002]
More particularly, the present invention relates to a
pharmaceutical composition for the prevention of transition
to surgical therapy for benign prostatic hyperplasia, which
comprises an indoline derivative represented by a general
formula:
[Chem. 1]
lilt
(I)
N
CH3 OR2
110
R1
in the formula, R represents an aliphatic acyl group which
may have one or more of a halogen atom, a hydroxyl group, a
lower alkoxy group, a carboxyl group, a lower alkoxy-
carbonyl group, a cycloalkyl group or an aryl group as a
substituent group and may have an unsaturated bond in some
cases, a hydroxyalkyl group, an aliphatic acyloxyalkyl
1
CA 02582045 2012-11-13
=
group, a lower alkyl group which has a lower alkoxy group,
a carboxy group, a lower alkoxycarbonyl group, an aryl-
substituted lower alkoxycarbonyl group, a carbamoyl group,
a mono or dialkyl-substituted carbamoyl group or a cyano
group as a substituent group, an aromatic acyl group which
may have one or more halogen atoms as a substituent group,
a furoyl group or a pyridylcarbonyl group; Rl represents a
cyano group or a carbamoyl group; and R2 represents a lower
alkyl group which may have one or more of a halogen atom, a
cyano group or an aryl group as a substituent group, or a
pharmaceutically acceptable salt thereof as an active
ingredient, and the like.
[0002a]
In one particular embodiment, the indoline derivative
represented by general formula (I) is silodosin.
Background Art
[0003]
Benign prostatic hyperplasia is a disease which has
high generation frequency in aged males, and it is said
that 70% of males of sixties are suffering from this. In
the aging society of recent years, the number of patients
of benign prostatic hyperplasia has been increasing and
drawing great attention.
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[0004]
Main therapeutic methods for benign prostatic
hyperplasia are drug therapy and surgical therapy. As the
surgical therapies, open prostatectomy, transurethral
resection of the prostate (TUR-P), thermotherapy, laser
2a
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therapy, stent indwelling method and the like are known.
The open prostatectomy becomes indication in the case of
large size of prostate, in the case of repeated urinary
retention and the like, but is most invasive. TUR-P is a
method in which an endoscope is inserted from urethra, and
the prostate is cut off with an electric surgical knife
from the inside while observing the prostate using a
mirror. Currently, this is the most popularized standard
method as the surgical therapy for benign prostatic
hyperplasia, which is carried out on about fifty thousand
cases a year in Japan and about three hundred thousand
cases a year in the United States. In comparison with the
open prostatectomy, bleeding is little, and recovery after
the operation is quick. Also, the thermotherapy is a
method in which opening of the urethra is improved by
destroying tissue of the prostatic inner gland by heating
them through the irradiation of microwave from the urethra.
This is a therapeutic method which can be carried out for
out-patients, causes little pain and is effective on the
benign prostatic hyperplasia of moderate or less severity.
The laser therapy is a method in which the tissue of
prostatic hypertrophy adenoma is allowed to undergo
necrosis or is destroyed by irradiating laser. Since the
method has many advantages in comparison with TUR-P, such
as little bleeding, short treating period of time, little
pain in patients and the like, this is drawing attention as
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a highly advanced therapeutic method ranking with the
thermotherapy. The stent indwelling method is a method in
which a duct (stent) is indwelled in a urethral part
thinned by the pressure of swollen prostate (e.g., see Non-
patent Reference 1).
[0005]
As the drug therapy for benign prostatic hyperplasia,
an al adrenoceptor antagonist, an anti-androgen drug, a
herb medicine and the like are used. It has been reported
that the effect of an al adrenoceptor antagonist,
tamsulosin hydrochloride, to reduce storage disorder is
indicated to be similar to that of TUR-P in short terms
(e.g., see Non-patent Reference 2).
[0006]
In deciding the therapeutic method, in general,
overall severity based on I-PSS (International Prostate
Symptom Score) total score, QOL score, maximum flow rate,
residual urine volume and prostate volume is used. For
example, when the overall severity is moderate or more,
surgical therapy such as the TUR-P or the like become the
indication (e.g., Non-patent References 3 and 4). However,
since there are many patients who do not desire the
surgical therapy as an invasive treatment, the development
of a drug which can prevent the transition to a surgical
therapy in severe patients who are subject to the surgical
therapy has been desired.
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[0007]
The indoline derivative represented by the above
general formula (I) or a pharmaceutically acceptable salt
thereof is markedly useful as an agent for the treatment of
dysuria associated with benign prostatic hyperplasia and
the like, because it has a selective inhibitory activity
against urethral smooth muscle contraction and can lower
urethral pressure without great influence upon blood
pressure (see Patent References 1 to 3). However, there
are no descriptions or suggestions therein that the above
indoline derivatives (I) or pharmaceutically acceptable
salts thereof, particularly a compound represented by the
following formula (II) (generic name: silodosin), can
prevent the transition of a patient with benign prostatic
hyperplasia who is subject to surgical therapy to the
surgical therapy.
[0008]
[Chem. 2]
OH
CONH2
3 Es0 -
H
0
CF3
KMD-3213
[0009]
Patent Reference 1: JP-A-H06-220015;
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Patent Reference 2: International Publication No. 99-
15202 pamphlet;
Patent Reference 3: International Publication No.,
2004-22538 pamphlet;
Non-patent Reference 1: Satoru Takahashi, "Yoku
Wakaru Zenritsusen No Byoki (Good Understanding on
Prostatic Diseases)", published by Iwanami Shoten, March 4,
2004, pp. 58-94;
Non-patent Reference 2: B. Djavan, Shinyaku To Chiryo
(New Drugs and Treatments), No. 442, vol. 53, no. 3, 2003,
pp. 11-12;
Non-patent Reference 3: Hainyo Shogai Rinsho Shiken
Gaidolain Sakusei Iinkai Hen (Edited by Urinary Disturbance
Clinical Test Guideline Preparation Committee), "Hainyo
Shogai Rinsho Shiken Gaidolain Daiichibu Zenritsusen
HidaiSho (Urinary Disturbance Clinical Test Guideline Part
1, Benign Prostatic Hyperplasia", published by Igaku Tosho
Shuppan, 1997;
Non-patent Reference 4: Hinyokika Ryoiki No Chiryo
Hyojunka Ni Kansuru Kenkyu Han Hen (Edited by a Research
Group on the Treatment Standardization in the Field of
Urology), "Zenritsusen Hidaisho Shinryo Gaidolain
(Guideline on the Medical Examination and Treatment of
Benign Prostatic Hyperplasia)", published by Jiho Shuppan,
2001, pp. 11-24.
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Disclosure of the Invention
Problem to be solved by the Invention
[0010]
The object of the present invention is to provide an agent
which can prevent the transition of benign prostatic
hyperplasia to a surgical therapy.
Means of Solving the Problems
[0011]
Taking the above problems into consideration, the
present inventors have conducted intensive studies and
surprisingly found that by administering an indoline
derivative represented by the above general formula (I) or
a pharmaceutically acceptable salt thereof, transition to
the surgical therapy can be prevented in patients with
benign prostatic hyperplasia who are subject to a surgical
therapy, thereby folming the basis of the present invention.
[0012]
That is, the present invention relates to,
[1] a pharmaceutical composition for the prevention
of transition to surgical therapy for benign prostatic
hyperplasia, which comprises an indoline derivative
represented by a general formula:
[Chem. 3]
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N 110
CH3 0)
N 11(!le
R/
in the formula, R represents an aliphatic acyl group which
may have one or more of a halogen atom, a hydroxyl group, a
lower alkoxy group, a carboxyl group, a lower alkoxy-
carbonyl group, a cycloalkyl group or an aryl group as a
substituent group and may have an unsaturated bond in some
cases, a hydroxyalkyl group, an aliphatic acyloxyalkyl
group, a lower alkyl group which has a lower alkoxy group,
a carboxy group, a lower alkoxycarbonyl group, an aryl-
substituted lower alkoxycarbonyl group, a carbamoyl group,
a mono or dialkyl-substituted carbamoyl group or a cyano
group as a substituent group, an aromatic acyl group which
may have one or more halogen atoms as a substituent group,
a furoyl group or a pyridylcarbonyl group; Rl represents a
cyano group or a carbamoyl group; and R2 represents a lower
alkyl group which may have one or more of a halogen atom, a
cyano group or an aryl group as a substituent group, or a
pharmaceutically acceptable salt thereof as an active
ingredient;
[2] a pharmaceutical composition for the prevention
of transition to surgical therapy for benign prostatic
hyperplasia as described in the above [1], wherein the
indoline derivative is silodosin;
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[3] a pharmaceutical composition for the prevention
of transition to surgical therapy for benign prostatic
hyperplasia as described in the above [1] or the above [2],
wherein the surgical therapy is transurethral resection
of the prostate;
[4] a pharmaceutical composition for the prevention
of transition to surgical therapy for benign prostatic
hyperplasia as described in any one of the above [1] to
[3], which comprises administering to a patient who is
subject to surgical therapy;
= [5] a pharmaceutical composition for the prevention=
of transition to =surgical therapy for benign prostatic
hyperplasia as described in any one of the above [1] to
[4], wherein daily dose of the indoline derivative
represented by the above general formula (I) or a
pharmaceutically acceptable salt thereof is from 2 to 16
mg;
= [6] a pharmaceutical composition for treating a
patient of benign prostatic hyperplasia whose overall
severity is severe, which comprises an indoline
= derivative represented by the above general formula (I) or
a pharmaceutically acceptable salt thereof;
[7] a pharmaceutical composition for treating a
patient of benign prostatic hyperplasia whose overall
severity is severe as described in the above [6],
wherein the indoline derivative is silodosin;
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=
[8] a pharmaceutical composition for treating a
patient of benign prostatic hyperplasia whose overall
severity is severe as described in the above [6],
or [7], wherein daily dose of the indoline derivative
represented by the above general formula (I) or a
pharmaceutically acceptable salt thereof is from 2 to 16
mg;
[9] a method for the prevention of transition to
surgical therapy for benign prostatic hyperplasia, which
comprises administering an effective amount of an indoline
derivative represented by the above general formula (I) or
a pharmaceutically acceptable salt thereof;
[10] a method for the prevention of transition to
surgical therapy for benign prostatic hyperplasia as
described in the above [9], wherein the indoline derivative
is silodosin;
[11] a method for the prevention of transition to
surgical therapy for benign prostatic hyperplasia as
described in the above [9] or [10], wherein the surgical
therapy is transurethral resection of the prostate;
[12] a method for the prevention of transition to
surgical therapy for benign prostatic hyperplasia as
described in the above [9] or [10], which comprises
administering to a patient who is subject to surgical
therapy;
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[13] a method for the prevention of transition to
surgical therapy for benign prostatic hyperplasia as
described in the above [9] or [10], wherein daily dose of
the indoline derivative represented by the above general
formula (I) or a pharmaceutically acceptable salt thereof
is from 2 to 16 mg;
[14] a method for treating a patient of benign
prostatic hyperplasia whose overall severity is moderate or
more, which comprises administering an effective amount of
an indoline derivative represented by the above general
formula (I) or a pharmaceutically acceptable salt thereof;
[15] a method for treating a patient of benign
prostatic hyperplasia whose overall severity is moderate or
more described in the above [14], wherein the indoline
derivative is silodosin;
[16] a method for treating a patient of benign
prostatic hyperplasia whose overall severity is moderate or
more described in the above [14] or [15], wherein daily
dose of the indoline derivative represented by the above
general formula (I) or a pharmaceutically acceptable salt
thereof is from 2 to 16 mg;
[17] a use of an indoline derivative represented by
the above general formula (I) or a pharmaceutically
acceptable salt thereof, for manufacturing a pharmaceutical
composition for preventing the transition to surgical
therapy for benign prostatic hyperplasia or for treating a
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patient of benign prostatic hyperplasia whose overall
severity is moderate or more;
[18] a use described in the above [17], wherein the
indoline derivative to be used is silodosin;
[19] a use described in the above [17] or [18],
wherein daily dose of the indoline derivative to be used is
from 2 to 16 mg; and the like.
Effect of the Invention
[0013]
The pharmaceutical composition which comprises an
indoline derivative represented by the general formula (I)
or a pharmaceutically acceptable salt thereof is useful as
an agent for the prevention of transition to surgical
therapy for a patient of benign prostatic hyperplasia who
is subject to surgical therapy.
Best Mode to Practice the Invention
[0014]
In the above general formula (I), the term "lower
alkyl" means a straight-chained or branched alkyl having
from 1 to 6 carbon atoms, the term "hydroxyalkyl" means a
straight-chained or branched alkyl having from 2 to 6
carbon atoms and having a hydroxyl group, with the proviso
that said hydroxyl group is present at a position other
than the a-position, the term "lower alkoxy" means a
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straight-chained or branched alkoxy having from 1 to 6
carbon atoms, and the term "cycloalkyl" means a 5- to 7-
membered cyclic alkyl, respectively. In addition, the term
"aryl" means an aromatic hydrocarbon such as phenyl,
naphthyl or the like, the term "aromatic acyl" means acyl
of a carboxylic acid having aryl which has the same meaning
as defined above, the term "aliphatic acyl which may have
an unsaturated bond" means acyl of a straight-chained or
branched alkylcarboxylic acid having from 2 to 7 carbon
atoms or a straight-chained or branched alkenylcarboxylic
acid having from 3 to 7 carbon atoms, and the term
"aliphatic acyloxy" means alkylcarbonyloxyalkyl having from
4 to 13 carbon atoms and having a hydroxyl group
substituted with the above aliphatic acyl group, with the
proviso that said aliphatic acyloxy group is present at a
position other than the a-position, respectively. In
addition, the term "furoyl" means 2-furoyl or 3-furoyl, the
term "pyridylcarbonyl" means 2-pyridylcarbonyl, 3-
pyridylcarbonyl or 4-pyridylcarbonyl, and the term "halogen
atom" means a fluorine atom, a chlorine atom or a bromine
atom, respectively. In this connection, the indoline
derivative of the above general formula (I) can be prepared
by the method as described in Patent Reference 2, and as
said indoline derivatives, the above-mentioned silodosin,
namely (-)-1-(3-hydroxypropy1)-5-H2R)-2-{[2-({2-[(2,2,2-
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trifluoroethyl)oxy]phenylloxy)ethyl]aminolpropy1)-2,3-
dihydro-1H-indole-7-carboxamide, is preferable.
[0015]
In the above indoline derivatives represented by
general formula (I), solvates with pharmaceutically
acceptable solvents such as water, ethanol and the like are
also included.
[0016]
As the pharmaceutically acceptable salts of the above
indoline derivative, for example, a compound having a
carboxy group may be converted into its salt with an
inorganic base such as sodium, potassium, calcium or the
like or with an organic amine such as morpholine,
piperidine or the like. Also, among the indoline
derivatives, a compound in which the substituent group R is
a substituted or unsubstituted acyl group or a furoyl group
may be converted into its monoacid addition salt with
hydrochloric acid, hydrobromic acid, sulfuric acid,
methanesulfonic acid, benzenesulfonic acid, p-toluene-
sulfonic acid, acetic acid, citric acid, succinic acid,
tartaric acid, 2,4-dimethylbenzenesulfonic acid, 2,4,6-
trimethylbenzenesulfonic acid, (+)-camphorsulfonic acid,
(-)-camphorsulfonic acid, 4-chlorobenzenesulfonic acid, 2-
naphthalenesulfonic acid, 1-butanesulfonic acid, fumaric
acid, glutamic acid, aspartic acid or the like. In
addition, among the indoline derivatives, a compound in
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which the substituent group R is a substituted alkyl group
or a pyridylcarbonyl group may be converted into its
monoacid addition salt with hydrochloric acid, hydrobromic
acid, sulfuric acid, methanesulfonic acid, p-toluene-
sulfonic acid, 2,4-dimethylbenzenesulfonic acid, 2,5-
dimethylbenzenesulfonic acid, 2,4,6-trimethylbenzene-
sulfonic acid, (+)-camphorsulfonic acid, (-)-camphor-
sulfonic acid, 4-chlorobenzenesulfonic acid, 2-naphthalene-
sulfonic acid, 1-butanesulfonic acid, fumaric acid,
glutamic acid, aspartic acid or the like.
[0017]
The pharmaceutical composition of the present
invention for the prevention of transition to surgical
therapy for benign prostatic hyperplasia can be prepared by
mixing the indoline derivative represented by the above
general formula (I) or a pharmaceutically acceptable salt
thereof with commonly used drug preparation carriers.
[0018]
The drug preparation carriers may be used by
optionally combining them depending on administration
forms, and their examples include excipients such as
lactose and the like; lubricants such as magnesium stearate
and the like; disintegrating agents such as
carboxymethylcellulose and the like; binders such as
hydroxypropylmethylcellulose and the like; surfactants such
as macrogol and the like; foaming agents such as sodium
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bicarbonate and the like; dissolving aids such as
cyclodextrin and the like; acidity agents such as citric
acid and the like; stabilizing agents such as sodium
edetate and the like; pH adjusting agents such as phosphate
and the like, and the like.
[0019]
As the administration form of the pharmaceutical
composition of the present invention for the prevention of
transition to surgical therapy for benign prostatic
hyperplasia, for example, oral administration preparations
such as powders, granules, fine subtilaes, dry syrups,
tablets, capsules and the like; parenteral administration
preparations such as injections, patches, suppositories and
the like, and the like can be illustrated, and oral
administration preparations are preferable.
[0020]
It is preferable to prepare the above preparations in
such a manner that the indoline derivative represented by
the above general formula (I) or a pharmaceutically
acceptable salt thereof is administered within the range of
from 2 to 16 mg, particularly from 4 to 8 mg, per day per
adult, as the oral administration preparations.
[0021]
In the present invention, the patients of benign
prostatic hyperplasia who become the object of indication
are patients with a severity which becomes the indication
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object of surgical therapy, namely moderate or more,
excluding those patients who have urinary retention or
complications caused by benign prostatic hyperplasia, and
for example, patients of moderate or more based on the
criteria for judging overall severity of the above
guideline on the medical examination and treatment of
benign prostatic hyperplasia can be illustrated, and
patients of severe are preferable.
[0022]
In the present invention, the surgical therapy for
benign prostatic hyperplasia means an invasive treatment
which is carried out with the aim of treating benign
prostatic hyperplasia, and a low invasive treatment is also
included therein. For example, open prostatectomy,
transurethral resection of the prostate (TUR-P),
thermotherapy, laser therapy, stent indwelling method and
the like can be illustrated, and TUR-P is particularly
preferable.
[0023]
In the present invention, the prevention of
transition to surgical therapy means a therapy which is
carried out with the aim of avoiding the surgical therapy,
or prolonging operating time of the surgical therapy, in
the above patients who are subject to the surgical therapy.
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Examples
[0024]
The present invention is further illustrated in more detail
by way of the following Example. However, the present invention is
not limited thereto.
[0025]
. [Example 1]
Clinical effects in patients who are subject to surgical
therapy for benign prostatic hyperplasia
Based on the results of a placebo-controlled,
parallel groups-comparing double blind trial carried out in
patients of benign prostatic hyperplasia, clinical effects
of silodosin and tamsulosin hydrochloride in patients who
are subject to surgical therapy were evaluated. As the
patients who are subject to surgical therapy, patients
whose overall severity before administration was "severe"
based on the criteria for judging overall severity (Non-
patent Reference 3) were extracted.
[0026]
Objects: 147 patients who are subject to surgical
therapy for benign prostatic hyperplasia
Administration method: oral administration for 12
weeks
Administered groups: Silodosin group (4 mg
silodosin/once, twice a day, 63 patients), Tamsulosin group
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(0.2 mg tamsulosin hydrochloride, once a day, 55 patients)
and Placebo group (placebo drug, 29 patients).
Primary endpoints: I-PSS total score, QOL score
Criteria for judging overall severity: in the
severity of respective judging items shown in Table 1, the
overall severity is regarded as "severe" when "severe" is
present in 2 items or more. In this connection, the Qmax
in the table means maximum flow rate (mL/second), RU means
residual urine volume (mL) and PV means estimated prostate
volume (mL) by ultrasonic tomography.
[Table 1]
[0027]
Table 1. Criteria for judging overall severity
Respective judging Moderate Severe
items
1. I-PSS total 8 - 19 20 - 35
score
2. QOL score 2, 3, 4 5, 6
3. Qmax, Residual Qmax: 5 mL/sec or more Qmax: less than 5
urine volume and RU: less than 100 mL/sec
mL or RU: 100 mL or
more
4. Estimated 20 mL or more, and less 50 mL or more
prostate volume than 50 mL
(PV)
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[0028]
I-PSS items questioned
(1) Sensation of residual urine
"Have you had a sensation of not emptying your
bladder completely after you finished urinating?"
(2) Urination within 2 hours
"Have you had to urinate again less than two hours
after you finished urinating?"
(3) Intermittency of urinary stream
"Have you found you stopped and started again several
times when you urinated?"
(4) Urgency
"Have you found it difficult to postpone urination?"
(5) Power of urinary stream
"Have you had a weak urinary stream?"
(6) Straining during urination
"Have you had to push or strain to begin urination?"
The scores of (1) to (6) are as follows.
Not at all: 0 point, less than 1 time in 5: 1 point,
less than 1 time in 2: 2 points, about 1 time in 2: 3
points, more than 1 time in 2: 4 points, almost always: 5
points.
(7) Nocturia
"How many times did you get up to urinate from the
time you went to bet at night until the time you got up in
the morning?"
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The scores are as follows.
None: 0 point, 1 time: 1 point, 2 times: 2 points, 3
times: 3 points, 4 times: 4 points, 5 times or more: 5
points.
[0029]
QOL score
"How do you feel if the present condition of
urination will continue from now on?"
Very satisfied: 0 point, satisfied: 1 point,
generally satisfied: 2 points, neither satisfied nor
unsatisfied: 3 points, a little unsatisfied: 4 points,
unsatisfied: 5 points, very unsatisfied: 6 points.
[0030]
Results
Regarding the case of patients whose overall severity
before administration was severe based on the criteria for
judging overall severity (Non-patent Reference 3), changes
in I-PSS total score and QOL score at the final evaluation
were compared. The results are shown in Table 2 and Table
3, respectively. In this connection, comparison between
the administration groups was carried out by two sample t-
test, and in the tables, "*" and "*" show that significant
differences were found at significance levels of less than
5% and less than 1%, respectively, and "N.S." means that a
significance was not found.
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[0031]
[Table 2]
Table 2. Change in I-PSS total score
Change in I-PSS at
Administration I-PSS before the end
Cases
groups administration Mean standard
deviation
Silodosin 63 22.8 -12.0 + 7.1 1) * 2) **
Tamsulosin 55 21.9 -8.6 + 6.2 N.S.
Placebo 29 23.5 -8.2 8.2
1) Silodosin group vs. Placebo group
2) Silodosin group vs. Tamsulosin group
3) Tamsulosin group vs. Placebo group
*: P < 0.05 ; **: P < 0.01; N.S.: no significance
[0032]
[Table 3]
Table 3. Change in QOL score
Change in QOL at
Administration QOL before
Casesthe end
groups administration
Mean SD
Silodosin 63 5.5 -2.3 + 1.6 1) "2) "
Tamsulosin 55 5.3 _1.5 +1.3 3) N.S.
Placebo 29 5.3 -1.4 1.3
1) Silodosin group vs. Placebo group
2) Silodosin group vs. Tamsulosin group
3) Tamsulosin group vs. Placebo group
**: P < 0.01; N.S.: no significance
[0033]
As shown in Table 2, Silodosin group significantly
improved the I-PSS total score in the patients of benign
prostatic hyperplasia whose overall severity before
administration was severe. The effect of Silodosin group
was statistically significant in comparison with Placebo
group and Tamsulosin group. In addition, as shown in Table
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3, Silodosin group also improved QOL score statistically
significantly in comparison with Placebo group and
Tamsulosin group. Based on this, it was shown that
silodosin significantly improves I-PSS total score in
patients of benign prostatic hyperplasia who are subject to
surgical therapy and has an effect to avoid transition to
surgical therapy.
[0034]
Next, the effect of each administration group to
improve the severity of I-PSS total score was evaluated in
the patients of benign prostatic hyperplasia whose overall
severity before administration was severe. The results are
shown in Table 4. In this connection, comparison between
the administration groups was carried out by two sample
Wilcoxon test, and in the table, "*" and "**" show that
significant differences were found at significance levels
of less than 5% and less than 1%, respectively, and "N.S."
means that a significance was not found.
[0035]
[Table 4]
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Table 4. Improving effect on severity of I-PSS total score
Severity of subjective
symptoms at the end.
Comparison
Administra- Number of patients
Cases between
tion groups (%)
groups
Mild Moderate Severe
(0 - 7) (8 - 19) (20 - 35)
24 33 6 1) **
Silodosin 63
(38.1%) (52.4%) (9.5%) 2) *
12 34 9
Tamsulosin 55 3) N.S.
(21.8%) (61.8%) (16.4%)
6 11 12
Placebo 29
(20.7%) (37.9%) (41.4%)
1) Silodosin group vs. Placebo group
2) Silodosin group vs. Tamsulosin group
3) Tamsulosin group vs. Placebo group
*: P < 0.05; **: P < 0.01; N.S.: no significance
[0036]
As shown in Table 4, Silodosin group significantly
improved the severity of I-PSS total score in the patients
of benign prostatic hyperplasia whose overall severity
before administration was severe. That is, it can be seen
that the severity of I-PSS total score in about 38% of the
patients who were subject to surgical therapy was improved
to mild. The improving effect of Silodosin group was a
statistically significant deference in comparison with
Placebo group and Tamsulosin group.
[0037]
As shown above, in the placebo-controlled, double
blind, comparative clinical test, silodosin was able to
significantly improve I-PSS total score and QOL score of
the patients of benign prostatic hyperplasia whose overall
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severity before administration was severe and to improve
symptoms of the patients who are subject to surgical
therapy to a level outside of surgical therapy object, and
thereby to avoid transition to surgical therapy.
[0038]
[Example 2]
Effects on the objective symptoms of patients who are
subject to surgical therapy for benign prostatic
hyperplasia
Based on the results from a long-term administration
test in patients of benign prostatic hyperplasia, effects
of silodosin on objective symptoms of patients who are
subject to surgical therapy were examined. As the patients
who are subject to surgical therapy, patients whose overall
severities before administration were "moderate" and
"severe" according to the criteria for judging overall
severity described in the above Table 1 were extracted.
[0039]
Objects: 229 patients who are subject to surgical
therapy for benign prostatic hyperplasia
Administration method: 4 mg silodosin/once (can be
optionally reduced to 2 mg/once), twice a day, oral
administration for 52 weeks
Analyzed groups: 101 severe patients (reduced to 2
mg/once in 9 cases among them), 128 moderate patients
(reduced to 2 mg/once in 17 cases among them)
CA 02582045 2007-03-30
As an objective symptom, results of maximum flow rate
(Qmax) (mL/sec) are shown in Table 5.
[0040]
[Table 5]
Table 5. Improving effect on maximum flow rate (Qmax)
Before
Change after
Administra-
Groups Cases administration 52 weeks
tion group
(mean SD) (mean SD)
Severe Silodosin 101 8.9 3.0 3.2 4.9
Moderate Silodosin 128 10.3 3.0 2.3 5.3
[0041]
As shown in Table 5, the changes after 52 weeks of
silodosin administration were 3.2 mL/sec in the severe
group and 2.3 mL/sec in the moderate group, and the
improvement of the objective symptom was observed in each
group in comparison with the case of before administration.
Particularly, the effect was significant in the severe
group.
Industrial Applicability
[0042]
The pharmaceutical composition of the invention is
markedly useful as an agent for the prevention of
transition to surgical therapy, because it can
significantly improve subjective and objective symptoms of
patients who are subject to surgical therapy for benign
prostatic hyperplasia.
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